Compelling commentary on children's health

The Corn Refiners Association, known for bringing us high
fructose corn syrup (HFCS), is on the move to buff up the image of this bastard
sweetener.Long felt to be a
contributor to our growing obesity problem, HFCS has been referenced as “the
crack of sweeteners.”You can see
one of the CRA’s YouTube videos here.Propaganda?Look at the
video, read on and make your own decision.

So what’s the scoop?Is HFCS really the evildoer that some would have us believe?Here’s what you need to know:

Processed sugar 101.HFCS is a processed sweetener made from
corn starch and it contains a high level of fructose (found in fruits and
honey) and glucose.HCFS is made
up of about 50 percent fructose and 50 percent glucose, which is about the same
composition of table sugar.While
it may be from corn, HFCS’s refined composition results in remarkably quick
absorption which can impact a child’s insulin levels quickly and
drastically.And this stuff is
everywhere, from ketchup to twinkies.Manufacturers love it because it’s 75% sweeter than sugar, it blends
well into foods and it’s cheap.

HCFS and the obesity
link.The consumption of HFCS
has increased 250% over the past 15 years which has lead some to assume that
HFCS is the core thread in our obesity problem.Further, we consume approximately 300 more calories per day
than we did in 1985.According to
data cited by Michael Pollan in his book, In
Defense of Food, about a quarter of this caloric increase comes from
HFCS.But another quarter come
from fat and about half from grains.So while corn syrup isn’t helping matters, it definitely isn’t operating
alone.Beyond it’s pervasive
presence in just about everything our children eat and it’s propensity for
quick absorption, there’s nothing specific about a HFCS calorie that puts a
child at higher risk for getting fat.

Bottom line.So while HFCS may not
represent an independent threat to our children, it’s the volume of consumption and the
context in which our children consume HFCS that represents a problem.Processed foods high in calories and
fat taken in quantity will put any child at risk for overweight.If you really want to minimize HFCS,
read your labels.But be prepared
to find it everywhere.Your best general
move is to minimize processed foods and offer whole foods whenever possible.

For a little fun check out A Life Less Sweet and follow one family's journey to eliminate HFCS from their world.

At a national pediatric meeting today I attended a lecture on obesity. Simultaneously in the next room was a lecture on crohn’s disease. The crohn’s lecture was standing room only with attendees spilling into the lobby. The room with the obesity lecture was nearly empty. The attendees were clustered to the rear of the room creating an embarrassing vacuous space between the speaker and the audience.

The situation offers an interesting contrast.

Was it an issue with the speakers? No, both were nationally recognized experts. Were there refreshments drawing attendees into the crohn’s lecture? No. Or is it that doctors just don’t care about obesity? I don’t think this was the case either.

I think the anemic attendance reflects a general attitude of physicians toward obese children: They’re difficult and frustrating. Many feel a lack of control with their overweight patients. Successful and sustained weight loss among kids is a rarity and fatalistic thinking among caregivers is as widespread as the problem itself. Physicians, like most of us, have a need to feel that what they’re doing is making a difference. And when we feel like we can’t make a difference there’s a natural tendency to pull back … or go to different lecture.

This is interesting: According to a study just published, preschoolers consume 30% more food when eating in large groups compared to small groups. Kids between the ages of two and six were studied when eating in groups of three and nine. The researchers found that group size and snack duration were significant and independent predictors of the amount that children will eat.

This is a phenomenon referred to as social facilitation and it’s seen in adults. Studies have demonstrated that adults eat 30% to 50% more when eating in groups compared to eating alone.

Can we extrapolate this for picky eaters? Probably. Children with other issues such as oral sensory aversion (gagging with complex textures) will often overcome their aversion in social feeding circumstances. In other words, children with feeding disorders can, in some cases, overcome their difficulties among their peers. This is probably more powerful once children hit four or five year of age, or once the biological drive to eat becomes mediated by social and environmental forces.

This is interesting given the recent New England Journal of Medicinearticle on social networks and obesity. Essentially, our friends and the company we keep may help determine the way we eat and the way we look. And kids seem to be no different.

Should a bilious M&M eating monster with a BMI of 40 be serving as the model of health for the next generation? While I think not it appears that the Department of Health and Human Services has other ideas and recently signed Shrek as the next great American hope to stifle growing young waistlines. As crazy as it may sound, HHS is in good company. McDonalds, never to be outdone by the government, subsequently hired the corpulent ogre to peddle “milk and apples.”

A study published in this month’s Pediatrics shows that increased body fat in young girls is associated with earlier onset of puberty. 354 girls were followed from 36 months through 6th grade and assessed for pubertal development. It seems a child’s body mass index (BMI) at 36 months and its rate of change between 36 months and first grade seem to be consistently associated with early puberty.

Early puberty is associated with a variety of psychosocial problems including the early initiation of alcohol use and sexual activity. Feel free to add this to the growing list of problems facing our overweight kids.

If you’re concerned about the amount of time kids are spending outside this article by Richard Louv is worth a look. His movement to reconnect children to the natural world began with his 2005 book, Last Child in the Woods. He fears that the resulting disconnect with the outdoors that has created an epidemic of nature-deficit disorder in children. If you can look beyond this trendy pseudodiagnosis he actually has something to say.

While urban and suburban parents cite stranger-danger as the drive indoors, it was interesting to learn that the number of child-snatchings (100/year) hasn't changed in two decades.

My favorite quote came when Louv interviewed one suburban fifth grader about his reclusive habits and was told, “I like to play indoors better ‘cause that’s where all the electrical outlets are.”

Boston’s Metrowest Community Health Foundation has created a stir with a new ad campaign showcasing the dangers of ignoring childhood obesity. Provocative billboards depict obese children with warnings of type 2 diabetes, heart disease, stroke, cancer and sleep apnea.

What’s more interesting than the ads is the reaction that they have drawn. It seems there are those who want to protect the sensibilities of children at the expense of their health. And then there’s the tired excuse that addressing overweight will create a generation of anorectics.

While childhood obesity is complex, the failure of parents to implement structure and feeding discipline in lives of their children is an often overlooked step in making some children obese. Kudos to Martin Cohen, Metrowest Foundation president, for brazenly reminding parents about the consequences they can expect from the daily choices they make.

When it comes to media coverage of the obesity epidemic it seems the voice of NYU’s Marion Nestle is everywhere. In an article last week covering the Canadian angle on aggressive food marketing to kids, Dr. Nestle says “I want to see an environment that makes it easier for parents to do the right thing.”

This is reassuring for those parents who consider themselves victims of Big Food. I can't say that I agree, however. Irrespective of the amount of money food manufacturers spend on marketing, they’ve yet to find a way to make Twinkies jump into shopping carts on their own. When mom and dad don't buy it, it aint in the pantry.

I work closely with a number of pediatric dieticians. Their involvement is key in managing the obese children that have become a daily occurrence in my clinic. All of them are skilled but one stands above the rest. This particular dietician seems to have better outcomes. Her patients do what they’re supposed to do: they’re compliant and they lose weight.

So what does she do so well that makes things work? She’s absolutely passionate about overweight and she motivates children and parents to change their lives. Some dieticians simply counsel, others stand up and engage in relationships that change lifestyles.

I’ve wondered whether overweight families and their dietary dysfunction would best be served by obesity coaches. This new allied professional would be something of a dietician-psychologist hybrid, or life-coach for the obese. And if the results I’ve seen with one passionate dietician are any indication of potential, it’s hard to believe that it wouldn’t be cost effective.

It seems Mickey Mouse has jumped on board the obesity gravy train and everyone’s cheering. The execs at Walt Disney World announced this week that new measures were underway to make their parks less of a threat to the young American waistline. We can now rest assured that during our once-in-a-lifetime trip to the Magic Kingdom the absence of trans fats will make our kids just a little bit better off.

But don’t blame Walt Disney or its corporate managers. The pressure to engage in this type of public posturing is intense. There’s a witch hunt underway and Mickey’s in the crosshairs. And just like the afternoon parade on Disney’s Main Street, the response is staged, predictable and above all else, very entertaining.